Journal archive · Rib, ear and septal grafts · Ethnic, Asian, Middle Eastern, African and Latino rhinoplasty · Open versus closed approach · 2026
Asian Rhinoplasty Using Exclusively Auricular Cartilage Through a Closed Approach
Gu Q, Fu Z, Li J, Yan S, Wu S, Sun Y.
What this paper says
In 63 Asian patients, a closed-approach rhinoplasty using only ear cartilage for the tip framework and diced ear cartilage for the bridge produced measurable improvement in every aesthetic index and higher satisfaction at 12 months.
Overview
Open rhinoplasty risks a visible columellar scar and synthetic implants risk infection, so the authors from Zhejiang Provincial People's Hospital designed a technique using neither. Between October 2022 and June 2024, patients had incisions inside both nostrils; a strut, septal extension graft and tip grafts were built from ear cartilage, and the dorsum was filled with diced ear cartilage. Aesthetic indices were measured in Photoshop before surgery and at 12 months.
Sections of note
- 63 patients aged 18 to 45 (mean 25.6).
- All measured aesthetic indices improved significantly (P < .05).
- VAS and ROE satisfaction scores improved significantly (P < .05).
- 3D imaging showed nasal volume increased by a mean 2.9 mL; volume did not change between 6 and 12 months (P > .05), indicating the graft did not shrink over that interval.
- Level of Evidence 4.
What it means for a patient
- Augmentation without a silicone implant, without a rib harvest and without an external scar is possible using ear cartilage alone.
- In this series the added volume was stable from 6 to 12 months.
- Ear cartilage is limited in quantity and is softer than rib, which may restrict how much augmentation it can provide; the study does not address larger augmentations.
Why this paper matters
It presents an all-autologous, all-closed alternative to the implant-based augmentation common in East Asia. Limits: single centre, 12-month follow-up, no comparison group.
Terms
- Auricular (conchal) cartilage: cartilage from the bowl of the ear.
- Diced cartilage: cartilage cut into small pieces so it can be moulded.
- Septal extension graft: cartilage fixed to the septum to lengthen or project the tip.
- VAS: visual analogue scale, a 0-10 satisfaction line.
- ROE: Rhinoplasty Outcome Evaluation, a satisfaction questionnaire.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
From the abstract
“In rhinoplasty, the open approach carries potential risks such as hypertrophic scarring, whereas synthetic implants carry potential risks like infection. Therefore, we propose a new technique that utilizes exclusively auricular cartilage for both framework construction and dorsal augmentation through closed approach.…”
Excerpt; the full abstract is on PubMed.
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Ethnic, Asian, Middle Eastern, African and Latino rhinoplasty
The nose in front of the surgeon decides the operation, not the patient's ancestry: skin thickness, cartilage strength and existing dorsal height set the limits of what any technique can deliver, and planning every nose toward one Caucasian ideal is the error the comparative data now names.
Open versus closed approach
Whether the surgeon opens the nose through a small incision across the columella or works entirely through the nostrils has been argued in print since 1973, was put on facing pages of Plastic and Reconstructive Surgery by Jack Gunter and Jack Sheen in 1997, and was finally pooled in 2025: across twenty studies and 1,067 patients there is no significant difference in what patients report, in breathing, in complications or in swelling.
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